Chapter 10 from textbook Flashcards
1
Q
four mechanisms of dynamic stability in the shoulder
A
- bulk of muscle creating passive tension
- contraction of muscles that create approximation of the joint spaces, compression of articular surfaces
- joint motion which limits/tightens
- barrier effect of muscle
2
Q
what is the difference bewteen RTC disease and instability:
A
disease is things like tendinopathy, muscle strains, impingements, and instability has to do with the labrum
3
Q
Hill Sachs lesion
A
dent on the humerus where it hits into the glenoid, most commonly with an anterior dislocation
4
Q
bankart lesion
A
the anterio-inferior labrum detaches from the labrum due to disruption of the humerus with a dislocation of the
5
Q
what is the most common location of a clavicle fracture?
A
mid shaft
6
Q
how long for bone to heal
A
6-8 weeks
7
Q
posterior instability will present like…
A
posterior pain, uniplanar subluxation and pain with sagittal movements.
8
Q
GH to scap movement
A
120 degrees GH to 60 degreees scap upward rotations
9
Q
anterior shoulder dislocation vs posterior shoulder dislocation MOI
A
anterior: FOOSH, abducted, ER and extended arm
10
Q
Rockwood classifications, which types often require the least amount of time to RTP
A
types 1 and 2, 10 days to 2 weeks to return
11
Q
according to the rockwood, if the AC ligament is just strained, what type is this
A
type 1
12
Q
how does the AC ligament look in types 2-5
A
torn
13
Q
type 1 rockwood,
A
ac lig sprained, AC joint ok, CC ligament ok, delt and trap ok
14
Q
type 2 rockwood
A
AC lig torn, AC joint stretched, CC lig stretched, muscles possibly detached
15
Q
type 3
A
AC lig torn, AC joint, clavicle displaced upward/superior, CC torn and streched, muscules likely damanged
16
Q
type 4 rockwood
A
AC lig torn, AC joint, clavicle dislocated posteriorly into trap, CC lig partial or complete tear, and muscles likely detached
17
Q
type 5 rockwood
A
AC lig torn, AC joint dislocated up badly, CC torn, msucles detached
18
Q
type 6 rockwood
A
AC torn, AC joint dislocated collarbone downward, CC intact, and muscles either intact or detached.w
19
Q
what is the most common MOI of a AC joint injruey
A
blow to the superiorlateral contact with the adducted shoulder
20
Q
what is the sequence of events for RTC disease
A
microtrauma, tendinopathy, bursitis, osteophytes and then a tear
21
Q
instrinsic vc extrinsic factors RTC disease
A
intrinsic, weakness, scap dysfunction,
external: activities or job
22
Q
what part fo the plexus is involved in a stinger or burner?
A
upper cerivcal trunk (lower trunk , divisions and cord hard to hurt)
23
Q
MOI of a stinger
A
cervical lateral flexion, depression and traction
24
Q
can you go back to a game after a stinger or burner
A
yes if bilateral strength and sensation and no more sxs
25
paget schroetter disease
effot thrombosis usually in baseball due to high ROM of the shoulder in axillary-subclavian vein
26
2 CKC UE test for RTP?
1. UE CKC test (tape 91cm) males 21, females 23 (can be on knees )
2. UE Y-balance: looking 10% LSI
27
another functional UE RTP test
seated shot put with 6# ball
28
whatare the number 1 and number 2 types of dislocations in kids
shoulder is number 1 elbow is number 2
29
what is tennis elbow and what is golfers elbow
tennis is lateral
golfers is medial
30
what makes up most support of the elbow in extreme flexion and extension ROM
osseous structures
31
primary stailizers of the elbow joint
ulnotrochlear articulation, MCL, LCL
32
secondary stabilizers of the elbow
radial head, anterior and posterior capsule, common flexors and extensors
33
LCL origin
from the lateral epicondyle
34
what are the 4 components of hte LCL
the lateral ulnar collateral ligament, lateral radial collateral ligament, accessory lateral collateral ligament and the annular ligament
35
what is the primary elbow varus restraint
the lateral radial collateral ligament
36
what is the MCL complex made of
the anterior, posterior and transverse bandsw
37
what is the primary valgus restraint
the anterior band of the MCL.
38
what does the posterior band of the MCL do
restraint against pronation of the ulna
39
osis vs itis
osis is more of a degenerative thing, and itis is an acute inflammation
40
what hurts with lateral epiocondyllitis
the CRB is painful with resistance, and occasionally the extensor digitorum communis.
41
what is golfers elbow
medial epicondylitis
42
what muscle groups are hurt with ME
common flexor group, FCR, PL, PT, FCU and FDS
43
what are the two most commonly hurt things in ME
FCR and PT
44
describe medial apopohsitis
this is an overuse elbow injury in which the medial elbow is having pain and difficulty. medial elbow pain, and difficulty with speed and velocity
45
what is little league shoulder
a progression of medial elbow apophysitis, this is an avulsion fracture, from traction of valgus stress on ME.
46
which phases of movement cause the most pain in little league shoulder
late cocking and early acceleration
47
what is the best treatment for elbow apopysitis or LLS
rest and a change of position for 4-6 weeks. if this still creates sxs, full shut down until sxs resolve.
48
what is the common MOI for a distal biceps tear
when the elbow is suddenly pulled into extension from a flexed and supinated position
49
what is the common location of a distal biceps rupture
the radial tuberosity
50
what is posterior olecranon impingement or valgus extensio overload (VEO)? and what phase of movement causes it?
from throwing, and when the elbow is in full extension during ball release. osteophyts form from the repetitive extension on the medial side.
51
signs and symptoms of posterior oclecranon impingement/VEO?
clicking, locking, catching, crepitus, and occasional UCL laxity
52
normal flexion of the elbow
150 degrees
53
what is panners disease
OCD of the capitulum from poor blood supply
54
ages of panners
4-9
55
what causes panner
valgus force with lateral compression
56
is panner's self lmiting
yes, with rest
57
what is the difference between an oblique stress fracture and trasnverse on olecranon
oblique from inc valgus and extension force
transverse from triceps pulling and from extension forces
58
what is the typical MOI of a radial head stress fracture
FOOSH in a pronated position
59
what is the Mason Classification
for radial head fractures, scaled from 1-4
60
mason classification 1
non displaced, no distruption mechanically, non op is treatment
61
type 2 mason classification
displaced oer 2mm, angulation of >30 degrees, non-op or op, may need excision for pateints, or ORIF
62
mason classification type 3
comminuted fracture of radial head, need excision, fixation (less than 3 seg) or replacement
63
type 4 mason classficiation
fracture with elbow dislocation, excision, fixation if less than 3 seg, replacement, check soft tissue.
64
what is the most common fracture type in elbows in kids
supercondylar humeral fracture
65
MOI of supercondylar fractures
FOOSH in extension
66
gartland classification scale
for supercondylar humerus fractures
67
gartland type 1
supercondylar humeral fracture, non displaced less than 2mm non surgical
68
gartland type 2
displaced supercondylar humeral fracture, with postreior cortex intact, need surgery if unstable or displaced or angulated
69
type 3 gartland
displaced with no corticol cortex, surgical open or closed fixation
70
salter harris classification
for growth plate fractrures
71
salter harris 1:
no bone fracture, epiphysis serparates completly from the metaphysis
72
salter 2:
separation throughout growth plate then out through a portion of the metaphysis, triangular shape!
73
salter 3:
extensions from the joint surface to the weak zone and extends along the plate into the periphery.
74
salter 4:
surgery indicated extends through joing surface, epiphysis, full thick issue at growth plate, into metaphysos, complete split
75
salter type 5:
uncommon with compression of plate, poor prognosis
76
what bundle of the elbow ligaments are omost important for valgus strength
anterior bundle, of UCL/MCL
77
what muscle adds to stability of the UCL
the FCU
78
where is the posterior and anterior band of the UCL tightest
in higher degrees of flexion, over 90 degres. and anterior band is tightest less than 90 degrees flexion
79
which is more accurate for UCL tear MRI or MRA
MRA as per research
80
when can throwing start post UCL-R
throwing at 4 months, on mound at 6 months
81
what is cubital tunnel syndrome
Ulnar nerve entrapment, in the cubital tunnel in the ME
82
what is the most common kinds of nerve compression entrapments
CTS number one, than cubital tunnel
83
where will cubutal tunnel give you NT
in the little finger and ring finger
84
what will you get (what sign) with cubutal tunnel
Wartenberg's sign, where you cannot bring and adduct your little finger, and it drifts into extension/abduction
85
what is radial tunnel syndrome
compression of postreior interosseous nerve, off of the radial nerve in the tunnel
86
the radial nerve splits into the sensory nerve and post inteross nerve where
proximal to the supinator
87
where will you have focal ppoint tenderness with post int nerve entrap
at the supinator, 3-5 cm distal to the LE in the supinator
88
what happens if there is compression at the arcade of frosche
motor componenet of the Post int nerve (radial) finger and wrist extension weakness.
89
what is pronator syndrome
medial nerve entrapment between the two pronator heads
90
whta can the ligament of Schruthers compress
the median nerve
91
with median nerve compression, what signs and sxs do you get
thumb, index, middle and 1/2 ring finger
92
how can you differentiate if the median nerve is being compressed at PT or the ligament of schruthers/arch
will have pain with prontation testing in PT and will have pain with resisted middle finger extension at the arch
93
what is the most common carpal fracture
a scaphoid fracture is
94
MOI for scaphoid fracture
FOOSH (forced DF of wrist can happen too,not as common )
95
what are the borders of the anatomical snuff box
EPB, EPL and APL (double E's double L's)
96
how will a scaphoid fracture present,
pain with anatomical snuffbox palpation, pain with gripping, wrist extension, radial deviation
97
RTP following scaphoid fracture non op vc op,
when does rehab start
12-15 weeks non op, op 8-12 weeks REHAB STARTS WEEK 6
98
what is the distal aspect of Guyon's canal
the hook of the hamate
99
what is in the guyon canal
ulnar artery and nerve
100
MOI of a hamate hook fracture
FOOSH, repetitive stress from a bat or racquet,
non dominant hand in baseball and golf, dominant hand in racquet
101
RTP after hook hamate fracture
4-6 weeks post op, 6 weeks in cast if non op
102
____% chance of non union in hook hamate fractures
85
103
boxers fractrue is
fracture of 5Th MCfrom punching.b
104
boxer fractures with angulate in which direction
volarly
105
what is tricky about a boxer fracture if there is a rotation component to it
the 5th MC may actuvally be under the 4th when a fist is made
106
RTP boxers fracture
3-4 week in cast, then rehab starting at 6 weeks.
107
TFCC components
radioulnar dorsal and palmar ligaments, ulnolunate ligament, ulnotrquitral ligament, and ECU
108
MOI TFCC issue
FOOSH, with pronation, hyperextension and rotation
109
when is TFCC issues painful
full wrist flex or ext and forced ulnar deviation
110
what is the best imaging study to look at TFCC
fat suppressed MRI
111
post op TFCC RTP
3-4 months
112
how should wrist be splinted if TFCC suspected
wrist in slight flexx, with no room for Rad dev or ulnar dev
113
gamekeepers thumb
thumb UCL, skier falls onto poles
114
where is the thumb UCL tightest and loosest,
tight in thumb flexion, loose in thumb extnesion
115
what is a stener lesion
avulsion of the proximal UCL through the adductor apoineurosis
116
should a stener lesion have imaging
yes
117
how are partial tears of thumb UCL managed
thumb splica cast several weeks ago
118
RTP following thumb UCL repair
4 months
119
what is mallet finger
when the extensor digitorim communis tendon/extensor mechanism is disrupted. cannot hold finger in extension with PIP stabilized
120
what is the most common finger injury and which finger
mallet, and middle finger
121
what is a lag sign
when the DIP cannot be held in extension with PIP is stabilized
122
if there is blood under a nail in a finger deformity
refer immediately.
123
can you RTP with mallet finger
yes if you splint in extension
124
how to treat finger conditions
splinting for 8 weeks.
125
what is jersey finger
avulsion.rupture of the FDP from the volar base of DIP
126
where does the FDP act
on fingers 2-3-4
127
MOI of jersey finger
forced extension of the DIP while it is flexed.
128
how to know if it is just FDP or FDS as well
if just DIP cannot be flexed, FDP, if PIP cannot be flexed, FDS
129
if jersey finger is surgically managed, how long to heal
12-16 weeks
130
how long do you have to avoid gripping for jersey finger
6-8 weeks
131
what is the most common cause of carpal instability
scapholunate dissociateion between the scapolunate ligament.
132
what is a colle's fracture
a radial styloid fracture non displaced
133
how is the S/L ligament hurt
in wrist extension with UD
134
signs and sxs of S-L dissociation
pain and clicking with wrst movements, scaphoid will be volar and lunate will be dorsalw
135
what is watson's sign
identified instability, deviate the wrist from full UD to RD and apply volar pressure on scaphoid, if there is a clunk, this is positive
136
if you suspect s-l dissociation how do you splint,
in neutral,
137
s-l dissociation casting post op for how long, rehab starts at...., RTP at ...
10 weeks
12 weeks
RTP at 4-6 months
138
